Thoracoscopic repair of diaphragmatic hernia in neonates and children: a new simplified technique

Abstract

Needlescopic techniques have been used recently in different pediatric procedures, which made this type of surgery more feasible and less invasive with decreased hospital stay and improved cosmetic results. The technique is being developed further. New techniques with minor modifications are evolving every day. The objective of this study was to describe and assess the results that can be achieved by using a new simplified technique [Reverdin needle (RN)] in thoracoscopic repair of diaphragmatic hernia in neonates and children. Eighteen patients with symptomatic congenital diaphragmatic hernia (CDH), from Al-Azhar University Hospitals, Cairo, Egypt were assigned to elective thoracoscopic repair using RN to insert mattress sutures between the edges of diaphragmatic defects. The technique will be described in detail. A total of 18 diaphragmatic defects were repaired successfully; there were 12 males and 6 females with a mean age of 1.58 +/- 21 months (range, 5 days-9 months). Left-sided CDH was present in 12 cases (67%) and right-sided CDH in 6 cases (33%). The mean operative time was 30.7 +/- 1.18 min (range, 25-60 min) for each CDH repair. There were no intra or postoperative complications. There was one case of conversion and minimal blood loss. The mean postoperative hospital stay was 5.6 days (range, 2-10 days). There was only one case of mortality on the 10th postoperative day. There was no single case of recurrence. The new technique had all the advantages of thoracoscopy in children (less invasive, less pain, shorter hospital stay) combined with the advantages of reduced operating time, simplicity and feasibility. It may be preferable to intracorporeal suturing and knot tying.

Analysis of 29 consecutive thoracoscopic repairs of congenital diaphragmatic hernia in neonates compared to historical controls

“…This series of 29 consecutive, unselected patients is the largest in the medical literature that analyzes only CDH-T of congenital posterolateral diaphragmatic defects performed in the neonatal period. Previous reports have either presented smaller numbers, heterogeneous groups of varying ages, mixed hernia types (Bochdalek or Morgagni), or different operative approaches (laparoscopic and thoracoscopic) [4,[6][7][8][9]. Furthermore, previous reports have provided observational patient data but have not included control groups.…”

“…Recently, there have been increasing reports of the use of thoracoscopy for the repair of CDH. The published world experience with CDH-T of diaphragmatic hernia in neonates totals 40 patients, of which few are Bochdalek-type hernias [1][2][3][4][5][6][7][8][9]. This series of 29 consecutive, unselected patients is the largest in the medical literature that analyzes only CDH-T of congenital posterolateral diaphragmatic defects performed in the neonatal period.…”

“…Recent series on CDH-T have focused on short-term data such as technical feasibility of the operation and have selected 'ideal' patients that may not represent the overall CDH population [3,7,9]. Older infants or children undergoing an elective minimally invasive procedure may be anticipated to have different perioperative problems than a critically ill neonate.…”

“…However, surgeons have been reticent to use these methods for repair of congenital diaphragmatic hernia (CDH) because of the disease-associated pulmonary hypertension and perceived patient fragility. Since Silen et al [1] first reported thoracoscopic repair in 1995, the reported world experience has reached 119 cases, of which few are in neonates [2][3][4][5][6][7][8][9]. Here, we review our institutional experience with 29 consecutive neonatal thoracoscopic repairs of CDH of Bochdalek performed by our group since 2004 and compare them with historical controls.…”

Thoracoscopic repair of congenital diaphragmatic hernia: two centres’ experience with 60 patients

“…The potential advantages of the thoracoscopic approach include better surgical field visualisation, better wound cosmesis and the avoidance of thoracotomyassociated musculoskeletal deformities. Despite the growing interest in the field about this technique, only few series have been published in the literature, owing to the rarity of the disease [7][8][9][10][11][12][13][14]. In this study, we aim to review the experience of our two centres on surgical techniques and post-operative outcomes.…”